Long Distance Dedication: Remote Health Monitoring

Information technology plays an important role in many aspects of our society and is an emerging force in the healthcare industry. One area of health IT that shows great promise is remote health monitoring, which during the past 10 years has risen from humble beginnings to become a significant player in healthcare.

OncNG spoke with Joseph Kvedar, MD, director of the Center for Connected Health in Boston, MA, who explained that “remote health monitoring involves the use of sensor technologies, primarily to gather physiologic information about patients that allows care providers, as well as patients, to make decisions about the care without actually being in the same room.”

Remote health monitoring is designed to help empower patients in becoming more actively involved with their personal health management. Patients with a chronic illness, such as diabetes, asthma, or chronic heart failure, need to be motivated to follow management plans and make necessary lifestyle modifications in order to minimize the chances that they’ll develop additional complications that could further jeopardize their health, thus requiring expensive treatment. The feedback provided by constant monitoring can help reinforce adherence and good health practices. Researchers in remote health monitoring have even found that patients who use the technology make fewer unnecessary doctor visits and are less likely to require hospitalization. Remote health monitoring can also help reduce healthcare costs. “If an organization plans patient visits every three days at a cost of $100 per visit, for example, over a 60-day period, the cost is $2,000 for 20 visits." Mark VanderWerf, president of American Medical Development (AMD) Telemedicine, said that incorporating remote health monitoring into such a patient’s care may mean that patient “might only visit [the doctor’s office] seven to nine times in the 60-day period, so for each 60 days, you save in excess of $1,000.”

Remote health monitoring systems also provide tools for patients that enable them to learn about and understand their illness, so they can walk into a doctor’s office feeling more confident. Companies like Health Hero Network, Inc., Medtronic, Inc., and iMetrikus, Inc. have worked hard to incorporate educational modules into their products as a way to encourage self-management. OncNG spoke about the advantages of incorporating remote health monitoring tools into patient care with R. William Vandivier, MD, clinical director of the Chronic Obstructive Pulmonary Disease (COPD) Center at the University of Colorado Hospital. “I think ultimately they [the patients] get better care,” he said.

Hey, Buddy!

Self-management and education are essential parts of the treatment plan for patients who have a chronic illness, according to Health Hero Network, Inc., which has incorporated tools into its monitoring systems to enable patients to take a more active role in their own care. The Health Buddy System®, a user-friendly four-button device with a large screen, is the company’s flagship program. It “integrates home health monitoring technology with clinical information databases, Internet-enabled decision support tools, health management programs, and content development tools.” With the ability to support 130 programs—10 with National Committee for Quality Assurance certification—that remotely monitor 30 different conditions (eg, cardiovascular, endocrine, psychiatry), the Health Buddy can be used by practitioners in just about any medical specialty. Its educational content “can be combined into programs that address a single disease state or comorbid conditions or even trimorbid conditions,” says Suneel Ratan, Vice President of Business Development at Health Hero. “That’s the first degree of personalization for the patient—it’s personalized to their condition.”

The Health Buddy also sends a daily transmission of specified patient data based on a set of rules established by the healthcare professional depending on what illness is being monitored. Patients will spend about 10 minutes with the Health Buddy answering questions (eg, “How are you feeling today?”) and connecting other devices that measure vital signs so the information can be uploaded into the system. “It will assess [the patient’s] behavior and [give them] coaching about their behavior,” said Ratan. “They’ll be assessed about their knowledge of their condition and given feedback and [further] education about their condition.” The device dials into a set 1-800 number overnight and uploads data and results to a physician interface—which can manage up to 200 or 300 patients—for care managers and care providers to view the following morning. Patients whose vital signs and symptoms show an adverse change will be automatically placed at the top of a contact list, making it easier for a care provider to follow up with those patients at a higher risk, reducing the amount of time spent on the phone. This way, they’re “only managing the 5-7% who are showing up as high-risk for signs and symptoms on a given day,” said Ratan.

Additionally, Health Hero offers monitoring and educational capabilities for cancer patients through its chronic pain and cancer programs. The primary focus of the cancer program is to “address the physical and emotional needs of patients dealing with various types of cancer” such as lung cancer; offer support for patients undergoing chemotherapy, and assist in helping patients maintain a positive mental attitude. Features include educational information and medication reminders, symptom monitoring, and affirmation or fun trivia questions upon completion of each daily session.

All Linked Up

With a focus on providing user-friendly capabilities to upload realtime patient data from biometric devices into personal health records (PHR), iMetrikus is “a pioneer in Internet-based remote health monitoring systems [and] serves those managing asthma, diabetes, pulmonary disease, hypertension, cardiovascular disease, congestive heart failure [CHF], and HIV/AIDS.” Although MediCompass Connect®, which “enables the collection of data that can be shared by members with their care team between provider visits,” is iMetrikus’ main focus, it’s the MetrikLink that may be the more interesting health monitoring resource, due to its ability to connect to more than 30 monitoring devices from different companies. MetrikLink transmits information through a telephone line or over the Internet, enabling authorized members of the healthcare team to easily review patients’ data. As part of MediCompass, it serves as a “universal communication gateway that securely transfers data from health monitoring and point-of-care devices.” Robert Murphy, Senior Vice President of Marketing, told OncNG, that “MetrikLink is really where our core development is and where our unique place in the marketplace is.”

PortaScience Inc. is a company whose main focus is to “develop portable and easy-to-use tests” for many markets, including healthcare. The company has devised “low-cost disposable tests that yield quantitative results without the need for costly instruments” for a variety of medical specialties (including oncology). One product, the PortaWBC white blood cell count test, is ideal for the approximately 1.5 million patients nationwide who undergo chemotherapy every year. It is important for each of these patients to have their white blood cell (WBC) levels tested before every chemotherapy treatment; a portable tester is an ideal way to promote timely monitoring and ensure that WBC count is at the appropriate level before each session. The PortaWBC is the “first affordable WBC count test that patients can easily perform in the convenience of their home.” Some of the advantages include in-home convenience, laboratory accuracy, fast results, user-friendly capabilities, and inexpensive cost.

On the Flip Side

The companies that create and distribute remote health monitoring products are understandably enthusiastic about the technology’s potential to help improve healthcare outcomes in a variety of disease states and patient populations. But what do some of the healthcare professionals who have studied remote health monitoring and incorporated it into practice have to say?

One benefit of remote health monitoring technology touted by supporters is its ability to increase access to care for geographically underserved areas. Because patients in rural areas often have a much harder time than their urban and suburban counterparts when it comes to accessing medical care, a study is being conducted at the University of Colorado Hospital, under the direction of Dr. Vandivier, to measure the effectiveness of remote health monitoring in patients with COPD who live in urban and rural regions of Colorado. “Urban medicine is kind of different than rural medicine, so we’ve partnered with Kaiser Permanente, and we’re enrolling patients from both of our sites,” Dr. Vandivier told OncNG. “We’re also doing rural medicine, which we’re maybe even more excited about because a lot of patients out in these counties in Colorado that are rural or even frontier— which have even fewer people—have a lot harder time getting their medical care.”

The study, known as the Advanced eHealth for COPD in Colorado Program, is designed to “evaluate the impact of the eHealth approach on reducing healthcare costs and improving quality of life for participants.” The study will provide up to 400 patients with a pulse oximeter, a hand-held spirometer (for exhaled breath monitoring), a pedometer, and an electronic communication device, which they will use to make daily reports of their selfmonitored health information to healthcare

professionals at Kaiser and the University of Colorado, who will in turn provide patients with educational information about COPD and “contact any participant who has a monitored parameter in a questionable range and determine what interventions may be needed.” The study is also looking at the economic impact of remote health monitoring. Results from a pilot program showed that remote monitoring saved “nearly $3,200 per patient over just a 12-week period, largely by alerting healthcare providers to signs of developing problems before they ballooned into larger complications.”

Dr. Vandivier told OncNG, “Initially, I actually was skeptical of this sort of mechanism to teach patients about their disease and to administer care to them, but I am a true believer in it now. I think for our patients, it’s really made a huge difference.”

Another remote health monitoring program, conducted by the Center for Connected Health Information, is focusing on “extending the care community beyond the traditional walls of healthcare institutions by bringing healthcare to the everyday surrounding of the health consumer and their families.” Dr. Kvedar told OncNG that the Center runs many programs and initiatives to measure the effectiveness of remote monitoring of patients with chronic diseases. The Center has analyzed “the latest data on years of patients going through that kind of a process” and found that “the hospitalization rate for patients on the intervention is reduced from a former rate of 22% to 5%.” The Center is also looking at how “new models of care that extend and enhance the physician—patient relationship are emerging through innovation of technology and process.”

We had a bit to say on the topic of the patient—physician relationship in our February Cover Story, “The 21st Century Patient—Physician Relationship.”

With regard to his personal experience with remote health monitoring technology, Dr. Kvedar said, “Remote monitoring means that I can take care of almost all of the aspects that I would normally rely on the physical examination in the office to give me without being in the office with the patient.”

Even the government has recognized the importance of using remote health monitoring for patients with chronic illnesses. In fact, on February 15, US Senator Norm Coleman (R-MN) introduced the Remote Monitoring Access Act of 2007, which would “provide for coverage of remote patient management services for chronic healthcare conditions under the Medicare Program.” The text of the bill included nine statements (or “findings”), including: “Remote patient monitoring can make chronic disease management more effective and efficient for patients and the health care system” and “Utilization of these technologies not only improves the quality of care given to patients, it also reduces the need for frequent physician office appointments, costly emergency room visits, and unnecessary hospitalizations.”

How Could it Help You?

A March 2007 report by Newsweek stated that over the next decade, it will become increasingly more difficult for patients to find new oncologists. This gradual decline may be attributed to an ongoing rush of cancer patients, creating an increased demand on the already limited supply of physicians currently available.

The anticipated shortage is due not only to rising needs, but also to the limited rate at which oncologists are entering the field (approximately 10,400 oncologists are currently employed in the US, with only 500 new ones entering the field each subsequent year). The cause? Nearly half of these physicians are nearing retirement themselves. This accounts for an approximate 27 oncologists for every 100,000 US senior citizens.

Ultimately, it is the cancer patient who will suffer this staggering decline in healthcare accessibility. Because of the difficulty in training new physicians in an adequate and timely fashion, treatment will be unable to keep up. Among the various treatments at risk are cancer vaccines and recent advances in preventative care.

When asked if remote health monitoring could help to lessen the impact of this particular problem, Kvedar says, “There are several advantages to having a connective health view of the healthcare system. One of those is that individuals that can make informed decisions about patient care, including patients themselves, do not have to be doctors all the time.” Kvedar further discussed how remote health monitoring may make it easier for the physician to “take more of an oversight role in care. The technology allows for a complete physio-logic picture to be in front of a doctor, and perhaps a care provider that’s closer to the action, say a home care nurse, can make decisions about that care much more effectively because of the richness of the information.”

Do You Think Remote Health Monitoring Will Revolutionize the Healthcare Industry?

“I think that it’s more a question of technology has evolved and how it continues to evolve, how people market it to consumers, and individuals becoming more accustomed and acclimated to using the technology in their everyday lives. That’s where it becomes revolutionary.”

Robert Murphy

Senior Vice President of Marketing, iMetrikus

“We believe it has the power. We believe it’s going to take a lot of work to do it, but that in the next three to five years, you’ll see a significant increase in the number and types of remote monitoring that are occurring in our healthcare system.”

Suneel Ratan

Vice President of Business Development, Health Hero

“I do think it will revolutionize healthcare simply because it will help us get proper care to people in all sorts of situations. People are so much more electronically savvy these days that for the first time, they’re going to be able to actually use these kinds of systems. I definitely think it is important, but I also don’t think remote health monitoring is a substitute for real people.”

R. William Vandivier, MD

Clinical Director, COPD Center,

University of Colorado Hospital

Connected Progress Report 2006

Council on Aging — The Health Hero® Technology Platform

OncNG editor, Erin Romanski, also contributed to this article.